B) Phenols:
It includes acids and semisynthetic compounds in soap solution. It is some what toxic with a unpleasant smell. It is used for general purpose disinfectants for contaminated surfaces. It has no activity on spores.
Advantages of disinfection:This is the method used to sterlize the articles that are destroyed by head and the metalic objects prone to corosion. This is the most easy method of disinfecting articles.
Disadvantages:This method does not ensure sterlisation, because the disinfectants does not destroy the spores. Some disinfectants are injurious to the skin and articles.
Important points to remember:
1) The dis infectant chosen should be efficient to destroy pathogens.
2) They should be used in correct strength.
3) The articles should be fully submerged in it.
4) They are placed for a sufficient length of time.
5) They should not be injurious to the skin and articles.
6) The article should be thoroughly cleansed to remove the organic material which will protect the bacteria against the action of disinfectants.
7) The disinfectant should be inexpensive.
8) Instruments soaked in germicides must be adequately rinsed with sterlie water before being used.
133 HANDLING OF STERILE ARTICLES:
1) Always wear a mask when handling sterile articles.
2) Sterilized articles must be kept in containers or on sterile towels, and kept covered till used.
Never allow contact of unsterile with sterile articles.
3) Make sure there is no dampness. As this could make the things unsterile.
4) Never allow any unsterile article including the arms and hands, to pass over a sterile field.
5) Never touch the inside of a package or container with your fingers. Use the cheatle forceps.
6) To pull a cork from a bottle of sterile field, take care not to contaminate the inside part of the cork nor inside the rim of the inner side up, and then replace it without delay.
7) When lifting a cover from a sterile container, lay it down with the inner side up, then replace it without delay.
8) To carry a sterile a sterile bowl or other container, hold it with your hands underneath, and do not touch the rim.
Rules for use of cheatle forceps:
1) The sterile jar holding the forceps must be cleaned, resterilized and filled with fresh antiseptic lotion daily. The cheatle forceps should be cleaned and autoclaved or boiled.
2) When in use, keep the forceps at elbow level and pointed downwards, because if you lift it upwards the solution may run on to your hand and then back to the forceps, making it unsterile.
3) Put the forceps back into the jar immediately after use. Replace carefully without touching the rim of the jar. If the forceps becomes contaminated in any way, it must be resterilized before being put back into the jar.
Preparing articles for sterilization:
A convenient method often used to be prepared with sets of the instruments, swabs, sponges, dressings, towels and sutures needed form each type of operation or sterile procedure. These sets are packed into drums, bundles, or on trays, labeled and kept ready for sterilization. The articles should be carefully arranged so that those needed first are on top. They must be loosely packed for steam to penetrate. Drums must have the perforations opened. Bundles should have a double wrapper or close woven cloth or of paper.
Dressings, swabs and sponges are usually made of several thicknesses of surgical gauze. Raw edges must be folded in. swabs and dressings are again folded to the desired size. Sponges used for abdominal surgery need to be large, stitched around the edges and a piece of tape sewed to one corner.
When an artery forceps is clipped to the end of the tape, there is no risk of the sponge being left inside the abdomen.
Packing gauze is made in various sizes. Use gauze four times the width of the desired packing.
Fold the edges so that they meet in the middle, and again fold down the centre, and roll.
Cotton wool is prepared in various ways. Cotton balls of various sizes are prepared by rolling between the palms. Some may be needed for internal surgery, and for this the cotton ball must be covered with gauze and tied. This type of swab is grasped with a long handled forceps. Cotton squares of various sizes are to be cut for use in dressing wounds. Some may require to be covered with gauze.
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Instruments: Surgical instruments should be washed first in cold water, then in warm water with a detergent after use. Use a brush to clean well especially between the teeth of artery forceps and clamps. To be properly sterilized, there should be no trace of dried blood or discharge. Rinse in clean water, then boil for 5 minutes and dry well.
Sharp instruments, knives and needles should be dealt with separately, taking care to avoid cuts and puncture wounds.
Syringes and needles: As soon as possible after use, draw up some water into the syringe and push enough through each needle to make sure they are not blocked. Infected syringes (used for withdrawing blood or pus) should be washed immediately in a cold disinfectant solution. Next wash the syringes and needles in warm soapy water, using a bottle brush for the barrel. Rinse in clean water. Take care not to get barrels and plungers mixed. But keep them always paired together.
Needles should be examined carefully for sharpness. The tips may be rubbed carefully on a sharpening stone. Take care not to prick your finger as infection may be transmitted in this way.
Rubber tubing after use should be cleaned with cold water, then with hot soapy water. Then rinsed. The inside must be thoroughly clean. Then it is boiled, and hung over a rail to drain. Put away loosely coiled, to avoid kinking. Rubber catheters should be cleaned by running cold water, boil for 5 minutes, then dry, with a towel or by hanging up.
BIOMEDICALWASTE MANAGEMENT
Biomedical waste is the waste, which is generated by hospital, nursing homes, Clinic, dispensaries, veterinary institution, animal house. Pathological laboratory and blood bank and is not degradable.
Classification of waste:
1) General waste:
a) General sweeping. b) Kitchen waste c) Packing material. d) Paper pieces.
e) Waste from laundry, kitchen, wards and laboratory.
2) Infectious waste:
a) Human anatomical waste (human tissue, organ and body parts).
b) Microbiology and microtechnology waste (waste from Laboratory cultures, stocks or specimens of micro organisms lie or attenuated vaccines, human and animal cell culture used in research and industrial laboratories , waste from production of biological, toxins, dishes, and devices used for transfer of cultures.
c) Solid waste (items contaminated with blood and body fluids including cotton, ressing, soiled plaster casts, linen, beddings, other materials contaminated).
3) Sharps:
a) Hypodermic needles, stitching needles, needles attached with tubing.
b) Scalpel blades, razors, nails etc.
c) Broken glass materials, syringes, blood vials, edges of slides and cover slips in contact with infectious agents.
135 Segregation, packing, transporting:
1) Biomedical waste shall not be mixed with other wastes.
2) Bio medical waste shall be segregate into containers/ bags at the point of generation prior to its storage, transportation, treatment and disposal. The containers shall be labeled.
3) Notwithstanding anything contained in the motor vehicles act, 1988, or rules there under, untreated bio medical waste shall be transported only in such vehicle as may be authorized for the purpose by the competent authority as specified by the government.
4) No untreated bio medical waste shall be kept stored beyond a period of 48 hours: provides that if for any reason it becomes necessary to store the waste beyond such period, the authorized person must take permission of the prescribing authority and take measures to ensure that the waste does not adversely affect human health and the environment.
Measures to minimize health risk due to medial waste:
1) Use appropriate protecting clothing like apron, thick layer gloves, long boot with thick sole, face masks, eye glasses when required, with arrangement of disinfection and disposal arrangement for staff handling hospital waste.
2) Popularize use of color and emblem code on container bags.
3) Introduce monitoring and surveillance for problem areas or high risk areas.
4) Constitute a Hospital Acquired Infection control committee.
5) Incinerator.
6) Conforms to pollution control board norms.
7) Built in safety.
8) Easy to operate and maintain.
9) Minimum site work.
10) Shredder for plastic materials (plastic, bottles, syringes, IV sets etc) cuts plastic waste into small pieces of 1 cm size chips thus ensuring that syringes, and other plastic material are rendered nonrecyclable.
11) Segregation of waste from Hospital kitchen, canteen and house s inside the hospital premises is collected from house to house and transported to vermicomposting site.
Categories of bio medical waste:
Category No.I Human anatomical waste
Waste Human tissue
Human organs Human body parts, Treatment & disposal Incineration/ Deep Burial.
Colour coding Yellow.
Container Plastic bag.
136 Category No.II Animal waste
Waste Animal tissuers, orghans, body parts carcasses bleeding parts, fluid blood, experimental used in Research, waste generated by verterinary, hospitals colleges, Discharge from hospitals, Animal house.
Treatment & disposal Incineration/ Deep Burial.
Colour coding Yellow.
Container Plastic Bag
Category No.III Microbiology & Biotechnology
Waste Waste from labouratory culture, stocks or specimens of microorganisms, live or attenuated vaccines human and animal cell culture used in research and infectious agents from research and industrial laboratories, waste from production of biological, toxins, dishes and devices used for transfer of cultures.
Treatment & disposal Local Autoclaving/Microwaving/Incineration
Colour coding Yellow/Red
Container Plastic Bag/ Disinfected container Category No. IV Waste Sharps
Waste Needles, syringers, scalpels, blades, glass, etc that may cause puncture and cuts. This include both used and unused sharps.
Treatment & disposal Disinfection Chemical treatment with 1% hypochlorite solution/ local autoclaving/ shredding.
Colour coding Blue / White translucent
Container Plastic Bag/ Puncture proof container
Category No.V Discarded Medicines and Cytotoxic Drugs
Waste Waste comprising of outdated contaminated and discarded Medicines.
Treatment & disposal Incineration/ destruction and drugs disposal in secured landfills
Colour coding Black
Container Plastic Bag
Category No.VI Solid Waste
Waste Items contaminated with blood and body fluids including cotton, dressings, soiled plastercasts, linen, beddings, other material contaminated with blood.
Treatment & disposal Incineration autoclaving / microwaving
Colour coding Yellow/Red
Container Plastic Bag/ Disinfected container
137 Category No.VII Solid Waste
Waste Waste generated from disposable items other than the waste sharps such as tubings, catheters, intravenous sets etc.
Treatment & disposal Disinfection by chemical treatment with 1% hypochlorite solution autoclaving/microwaving and multilation / shredding.
Colour coding Red
Container Plastic Bag/ Disinfected container Category No.VIII Liquid Waste
Waste Waste generated from laboratory and washing cleaning, housekeeping and disinfecting activities.
Treatment & disposal Disinfection by chemical treatment with 1% hypochlorite solution and discharge into drains.
Category No.IX Incineration Ash
Waste Ash from incineration of any biomedical waste Treatment & disposal Disposal in municipal landfill
Color Coding Black
Container Plastic Bag
Category No.X Chemical Waste
Waste Chemical used in production in biologicals, chemicals used in disinfection, as insecticides, etc.
Treatment & disposal Chemical treatment with 1% hypochlorite solution and discharge into drains for liquids and secured landfill for solids.
Color Coding Black for solids
Container Plastic Bag
Summary:
Nurses are the persons who have frequent contact with the patients to provide care for 24hours.
It is the responsibility of the nurse to be aware of the patients at risk of developing infectious and also a duty to protect them with aseptic techniques.
ã Asepsis is the practice to reduce or eliminate contaminants (such as bacteria, viruses, fungi and parasites) from entering the operative field is surgery or medicine to prevent infection.
ã Three things that are extremely important is achieving asepsis are the reduction of time, trauma and trash.
ã The two types of aseptic techniques the nurse practices are medical and surgical asepsis.
ã Medical asepsis is a clean technique which includes procedure used to reduce the microorganisms and prevent their spread. (e.g.) changing patient’s bed linen daily, hand washing.
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ã It is a sterile technique which procedures used to eliminate the micro organisms. Sterile technique is used where sterile instruments are used (e.g.) in operation theatre.
ã Disinfection is the destruction usually by chemicals of pathogenic organisms not including bacterial spores.
ã The three main methods of sterilization are heat, chemicals, irradiation, and filtration.
ã The methods of disinfection are environmental, equipments, skin and wound, food medication, water, and vaccine.
ã The types of chemicals used for disinfection are alkylating agents and phenol.
Questions
Part A –– ANSWER IN ONE OR TWO WORDS: (One mark) 1) What is the sterile technique used to eliminate micro organism?
2) What is used for gaseous sterilization?
3) Which method is used to sterilize instrument and machines?
4) Which method is used to dispose dressings, laboratory media and human tissues?
5) What is the pressure maintained in the autoclave?
PART B –– MULTIPLE CHOICE QUESTIONS: (One mark)
1) The technique which includes procedures used to reduce the microorganisms and prevent their spread is
a) medical asepsis b) surgical asepsis c)sterilization d) disinfection 2) The basic technique for infection control is
a) Wearing mask b) wearing gloves c) wearing gowns d) hand washing.
3) To prevent soiling o f the nurses clo thing by the pat ient s blood and body fluids by wearing
a) mask b) gloves c) gown d) all of the above.
4) The destruction of microorganism by chemicals is
a) medical asepsis b) surgical asepsis c)sterilization d) disinfection 5) Exposure of heat resistant materials to steam under increased pressure is
a) autoclaving b) filtration c) steaming d) dry heat
6) A sterile technique is eliminate the micro organisms in operation theatres is known as a) Medical asepsis b) surgical asepsis c) disinfection d) none of the above 7) From inhaling large particles aerosols prevents by
a) Gown b) Mask c) Aprons d) Gloves
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8) Enamel and clear wares are sterilized by the method of a) Tyndallisation b) chemicals c) boiling d) radiation 9) The desired temperature for autoclaving is
a) 121ºc b) 112ºc c) 100ºc d) 125ºc
10) The effective sterilization for disinfecting wo rking surfaces and air inside the room
a) Chemical b) Ultra violet light c) Incineration d) none of the above 11) The instruments and machines for sterilization the chemicals used
a) Gluteraldehyde b) Propiolactone c) Ethylene oxide d) Formaldehyde 12) Which is not the general waste in the following items.
a) packing material b) kitchen waste c) solid waste d) proper pieces 13) The colour coding for disposing sharps and glasses is
a) yellow b) red c) blue d) black 14) The types of chemicals used for disinfection are
a) alkalizing agents b) Phenol c) both d) none of the above
15) The tubing’s, catheter & IV sets can be disposed in the following colour containers a) yellow b) black c) red d) blue
PART C –– WRITE SHORT NOTES ON: (5 Marks) 1) Principles of asepsis.
2) Principles of surgical asepsis.
3) Principles of disinfection.
4) Use of gloves;
5) Guidelines for maintaining medical asepsis.
PART D –– WRITE IN DETAIL: (10 Marks) 1) Explain about disinfection?
2) Describe about medical asepsis?
PART E –– WRITE ESSAY: (20 Marks) 1) Sterilization and disinfection.
2) Medical and surgical asepsis.
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